§ 689C.1671 — Coverage for drugs, laboratory testing and certain services related to human immunodeficiency virus and hepatitis C required; reimbursement of certain providers of health care for certain services; prohibited acts

Nevada § 689C.1671

• Jurisdiction: Nevada
• Title 57: INSURANCE
• Ch. 689C: Health

Text

1. A carrier that offers or issues a health benefit plan shall include in the plan coverage for:
(a) All drugs approved by the United States Food and Drug Administration for preventing the acquisition of human immunodeficiency virus or treating human immunodeficiency virus or hepatitis C in the form recommended by the prescribing practitioner, regardless of whether the drug is included in the formulary of the carrier;
(b) Laboratory testing that is necessary for therapy that uses a drug to prevent the acquisition of human immunodeficiency virus;
(c) Any service to test for, prevent or treat human immunodeficiency virus or hepatitis C provided by a provider of primary care if the service is covered when provided by a specialist and:
(1) The service is within the scope of practice of the provider of primary care; or
(2) The provider of primary care is capable of providing the service safely and effectively in consultation with a specialist and the provider engages in such consultation; and
(d) The services described in NRS 639.28085 , when provided by a pharmacist who participates in the health benefit plan of the carrier.
2. A carrier that offers or issues a health benefit plan shall reimburse:
(a) A pharmacist who participates in the health benefit plan of the carrier for the services described in NRS 639.28085 at a rate equal to the rate of reimbursement provided to a physician, physician assistant or advanced practice registered nurse for similar services.
(b) An advanced practice registered nurse or a physician assistant who participates in the network plan of the carrier for any service to test for, prevent or treat human immunodeficiency virus or hepatitis C at a rate equal to the rate of reimbursement provided to a physician for similar services.
3. A carrier shall not:
(a) Subject the benefits required by subsection 1 to medical management techniques, other than step therapy;
(b) Limit the covered amount of a drug described in paragraph (a) of subsection 1;
(c) Refuse to cover a drug described in paragraph (a) of subsection 1 because the drug is dispensed by a pharmacy through mail order service; or
(d) Prohibit or restrict access to any service or drug to treat human immunodeficiency virus or hepatitis C on the same day on which the insured is diagnosed.
4. A carrier shall ensure that the benefits required by subsection 1 are made available to an insured through a provider of health care who participates in the network plan of the carrier.
5. A health benefit plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 2024, has the legal effect of including the coverage required by subsection 1, and any provision of the plan that conflicts with the provisions of this section is void.
6. As used in this section:
(a) “Medical management technique” means a practice which is used to control the cost or use of health care services or prescription drugs. The term includes, without limitation, the use of step therapy, prior authorization and categorizing drugs and devices based on cost, type or method of administration.
(b) “Network plan” means a health benefit plan offered by a carrier under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the carrier. The term does not include an arrangement for the financing of premiums.
(c) “Primary care” means the practice of family medicine, pediatrics, internal medicine, obstetrics and gynecology and midwifery.
(d) “Provider of health care” has the meaning ascribed to it in NRS 629.031 .

Legislative History

(Added to NRS by 2021, 3208 ; A 2023, 3517 )